A pain in the wrist

Carpal tunnel syndrome a treatable affliction

September 13, 2012

LAURIUM - The human hand and wrist is full of bones, tendons and nerves, which can sometimes malfunction leading to discomfort at best and pain at worst.

One of those problems which can occur in the wrists is carpal tunnel syndrome, and Dr. Frederick Rau, orthopedic surgeon at Aspirus Keweenaw Hospital in Laurium, said it's often caused by genetics.

"Preventing it is mostly about choosing your parents wisely," he said.

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Kurt Hauglie/Daily Mining GazetteDr. Frederick Rau, orthopedic surgeon at Aspirus Keweenaw Hospital, explains how an incision is made in a wrist to get to the transverse carpal ligament during carpal tunnel syndrome surgery. The ligament is cut, relieving pressure on the median nerve.

Carpal tunnel syndrome is a problem of anatomy more than anything, Rau said.

"The back of the wrist forms a rigid gutter," he said. "That's a fixed space."

If that gutter is small, Rau said the tendon and the median nerve can rub against the transverse carpal ligament, which is fairly wide, causing swelling and pain.

"If things swell in a thin space, pressure goes up," he said.

Rau said if the median nerve swells, it can kink, adding to the pain.

There are several treatments for CTS, Rau said. Non-surgical remedies include cortisone injections or oral anti-inflammatory drugs.

"They can decrease the swelling of the tendons," he said.

Another non-surgical method for treating CTS is the use of hand braces during sleep, Rau said. The braces prevent the wrists from getting into positions which can put pressure on the median nerve.

"That's like the universal baseline treatment," he said of wrist braces.

The surgical remedy for CTS involves cutting the transverse carpal tendon, Rau said. A small incision is made in the palm and surgical tools are used to open the incision, which allows a cutting tool to reach the transverse carpal tendon, which is cut its entire width.

"That takes the pressure off," he said. "Then the deed is done."

The tendon is left cut, Rau said, and in about a month, scar tissue grows reconnecting the tendon, but with more space for the nerves and other tendons to move.

The surgery takes about 20 minutes, Rau said, and it's done on an out-patient basis.

Once surgery is done, Rau said most people don't have a recurrence of CTS.

"It's the minority, but it's possible," he said.

With the new surgical methods for treating CTS, Rau said the likelihood of the problem returning is low.

There are ways to reduce the likelihood of CTS, Rau said. Gel-filled pads placed in front of computer keyboards and wearing wrist braces during repetitive work are effective.

"They keep the wrist in a neutral position," he said.

Only about 3 to 4 percent of the thousands of CTS patients he's treated have experienced a return of the problem, Rau said.

When a person can go back to work after CTS surgery will depend what kind of work the person does, Rau said.